The "BioHumi" Humeral Head Osteochondral Allograft Transplantation for Reverse Hill-Sachs Lesion of the Shoulder

Abstract

Osteochondral defects of the shoulder due to posterior instability are less frequent than those caused by anterior instability. Although uncommon, locked posterior dislocations can create sizable osteochondral lesions of the anterior humeral head known as reverse Hill-Sachs lesions. Treatment of these defects to restore the congruent contour of the glenohumeral joint is essential to reduce recurrence of instability and prevent long-term sequelae of arthritis. Historically, nonanatomic options, such as transposition of the subscapularis tendon or lesser tuberosity into the defect and humeral rotational osteotomy, have been endorsed to treat reverse Hill-Sachs lesions. More contemporary techniques have focused on restoring not only the bony architecture but also the chondral surface using fresh osteochondral allografts. The evolution of this approach has been challenging because of the large impacted wedge-shaped defect typically encountered with a locked posterior dislocation. Many surgeons employ techniques using multiple circular grafts or customizing a nonanatomic graft to fill these defects. Given the unstable nature of these grafts, metallic screws are often placed through the chondral surface for fixation. The evolution of the "BioHumi" technique has made treatment of large reverse Hill-Sachs lesions technically simpler and more reproducible using innovative instrumentation to transplant an elliptical osteochondral allograft.

Fig 1

Demonstration of an axial cut of a computed tomography (CT) scan of a locked right shoulder posterior dislocation with a large reverse Hill-Sachs lesion of the humeral head (arrow).

Fig 2

Demonstration of an open deltopectoral approach of a right shoulder in the beach chair position with a large reverse Hill-Sachs lesion of the humeral head (arrow) from a locked posterior shoulder dislocation.

Fig 3

Demonstration of an open deltopectoral approach of a right shoulder with the patient in the beach chair position with sizing of a large reverse Hill-Sachs lesion of the humeral head (arrow) from a locked posterior dislocation in preparation for osteochondral allograft transplantation (OAT) using the BioHumi technique.

Fig 4

Demonstration of an open deltopectoral approach of a right shoulder with the patient in the beach chair position with a large reverse Hill-Sachs lesion of the humeral head (white arrow) from a locked posterior dislocation with the planned recipient site outlined (yellow arrow) after sizing in preparation for osteochondral allograft transplantation (OAT) using the BioHumi technique.

Fig 5

Demonstration of the sizer (arrow) on the proposed harvest site on a right fresh humeral osteochondral allograft in preparation for osteochondral allograft transplantation (OAT) using the BioHumi technique for a right shoulder large reverse Hill-Sachs lesion.

Fig 6

Demonstration of a right humeral fresh osteochondral allograft within the graft station with the proposed harvest site outlined (arrow) in preparation for osteochondral allograft transplantation (OAT) using the BioHumi technique for a right shoulder large reverse Hill-Sachs lesion.

Fig 7

Demonstration of the donor elliptical graft (arrow) after harvest from the right humeral head fresh osteochondral allograft in preparation for osteochondral allograft transplantation (OAT) using the BioHumi technique for a right shoulder large reverse Hill-Sachs lesion.

Fig 8

Demonstration of an open deltopectoral approach of a right shoulder with the patient in the beach chair position with a large reverse Hill-Sachs lesion of the humeral head from a locked posterior dislocation with the recipient site (arrow) prepared for graft implantation in preparation for osteochondral allograft transplantation (OAT) using the BioHumi technique.

Fig 9

Demonstration of an open deltopectoral approach of a right shoulder with the patient in the beach chair position with a large reverse Hill-Sachs lesion of the humeral head from a locked posterior dislocation with final implantation of the elliptical fresh humeral head osteochondral allograft (arrow) using the BioHumi technique.

Fig 10

Demonstration of anteroposterior (A) and axillary (B) radiographs of the right shoulder 4 months after osteochondral allograft implantation using the BioHumi technique for treatment of a reverse Hill-Sachs lesion after a locked posterior dislocation.